2018-11-13T11:02:56-06:00 2017-12-31 990 2017-01-01 810584868 Dallas Physician Medical Services for Children Inc DALL 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 Tammie Sibley Treasurer 2018-11-13 2017 2019-02-21 02:37:17Z Ray Tsai MD 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 11793410 false X N/A X 2002 TX PROVIDE SERVICES TO PATIENTS AT SEVERAL HOSPITALS, INCLUDING CHILDREN'S MEDICAL CENTER DALLAS. 3 0 31 0 0 0 0 10150397 11793410 0 0 10150397 11793410 0 0 8629602 10484013 0 0 4420579 4863371 13050181 15347384 -2899784 -3553974 1766527 768504 8564171 11120121 -6797644 -10351617 PROVIDE DENTAL, GENERAL PEDIATRIC, AND PEDIATRIC SUB-SPECIALTY SERVICES, INCLUDING, BUT NOT LIMITED TO EMERGENCY DEPARTMENT COVERAGE, INPATIENT COVERAGE, ORTHOPEDIC SURGERY, AND CRANIOFACIAL ORTHODONTICS. false false 13559686 11793410 PROVIDE PHYSICIAN SERVICES TO PATIENTS AT CHILDREN'S MEDICAL CENTER DALLAS. THESE SERVICES ARE PROVIDED WITHOUT REGARD TO THE PATIENTS' ABILITY TO PAY. 13559686 true false false false false false false false false false true false false false true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 26 0 true 31 true false false false false false false true false false false X 3 0 false false false false true true true true true false false false true true true true true false false false X Jeffrey Vawrinek 2144567000 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 William Morrow MD Dir. and Pres., DPMSC & Pres Phys Orgs and Acdmc Rel CCO, CHST 1.0 54.0 X X 0 927755 19867 John Polousky MD Board Member and Medical Director 50.0 0 X 829459 0 19120 Michael Tate MD Board Member and Medical Director 50.0 0 X 311399 0 25600 Ray Tsai MD Vice President, DPMSC & SVP System Ambulatory Services, CHST 1.0 54.0 X 0 628244 31511 Jerry Lee Treasurer, DPMSC & VP Accounting and Treasury, CHST 1.0 49.0 X 0 390313 32789 Lisa Frenkel Secretary, DPMSC & Associate General Counsel, CHST 1.0 49.0 X 0 268217 12100 Dustin Loveland MD Physician 40.0 0 X 695245 0 18844 Christopher Redman MD Physician 40.0 0 X 608877 0 17648 Kathryn Bauer MD Physician 40.0 0 X 533212 0 13199 David Brown MD Physician 40.0 0 X 434513 0 12706 Yongjong Park DDS Dentist Orthodontist 40.0 0 X 352309 0 11552 Stephanie Smith Former Officer, DPMSC & Sr Legal Counsel, CHST 0.0 50.0 X 0 140567 11005 3765014 2355095 225942 0 true true false COMPHEALTH PO Box 972651 Dallas TX 75397 Physician Services 575479 TCN PEDIATRIC NEUROLOGY PLLC 4032 McDermott Road Suite 100 Plano TX 75024 Physician Services 541750 GREATER DALLAS ORTHOPEDICS 12230 COIT RD STE 100 DALLAS TX 75251 PHYSICIAN Services 458616 Weatherby Locums Inc 6451 N Federal Highway Suite 800 Ft Lauderdale FL 33308 Physician Services 227869 ALINA OLTEANU 3001 AURORA DR Plano TX 75093 Physician Services 109701 5 0 PROFESSIONAL SVC REV 621110 11793410 11793410 0 0 0 0 11793410 0 0 0 0 0 0 0 0 0 11793410 11793410 0 0 X 1140858 1140858 7220294 7091887 128407 423323 415795 7528 1119244 1099339 19905 580294 569974 10320 2237452 2237452 0 0 43043 12468 30575 1818 1480 338 755745 741951 13794 24490 22832 1658 98152 94142 4010 22571 22571 84576 84512 64 Shared Services 1569587 1569587 Medical Surgical Supplies 12418 12418 Transltn & Interprtn Srvc 2847 2847 Dietary and Food Costs 1937 1665 272 8735 7495 1240 0 15347384 13559686 1787698 0 1618296 643421 0 0 0 576 0 172995 47912 147655 125083 0 0 0 0 1766527 768504 611165 623138 0 7953006 10496983 8564171 11120121 -6797644 -10351617 -6797644 -10351617 1766527 768504 X -3553974 1 X false true X true false X 172995 47912 125083 125083 LT ADVANCES-Affiliates 10496983 10496983 Schedule D, Part X, Line 2 THE DALLAS PHYSICIAN MEDICAL SERVICES FOR CHILDREN, INC.'S CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEAR ENDING DECEMBER 31, 2017 DO NOT CONTAIN A FIN 48 (ASC 740) FOOTNOTE. false true false false false false false true false William Morrow MD Dir. and Pres., DPMSC & Pres Phys Orgs and Acdmc Rel CCO, CHST 0 556606 0 291820 0 79328 0 10800 0 9067 0 947622 0 0 John Polousky MD Board Member and Medical Director 691680 0 133333 0 4446 0 10800 0 8320 0 848579 0 0 0 Michael Tate MD Board Member and Medical Director 300590 0 10000 0 809 0 16200 0 9400 0 336999 0 0 0 Stephanie Smith Former Officer, DPMSC & Sr Legal Counsel, CHST 0 124399 0 12883 0 3285 0 6793 0 4213 0 151572 0 0 Ray Tsai MD Vice President, DPMSC & SVP System Ambulatory Services, CHST 0 375621 0 207525 0 45098 0 14901 0 16610 0 659754 0 0 Jerry Lee Treasurer, DPMSC & VP Accounting and Treasury, CHST 0 278646 0 66547 0 45120 0 14507 0 18282 0 423102 0 0 Lisa Frenkel Secretary, DPMSC & Associate General Counsel, CHST 0 221768 0 40627 0 5823 0 6532 0 5569 0 280317 0 0 Dustin Loveland MD Physician 461475 0 226063 0 7707 0 10800 0 8044 0 714089 0 0 0 Christopher Redman MD Physician 468152 0 138448 0 2277 0 10800 0 6848 0 626525 0 0 0 Kathryn Bauer MD Physician 470774 0 58333 0 4104 0 10800 0 2399 0 546410 0 0 0 David Brown MD Physician 418082 0 13933 0 2499 0 3288 0 9418 0 447220 0 0 0 Yongjong Park DDS Dentist Orthodontist 339010 0 10000 0 3298 0 0 0 11552 0 363861 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation CHILDREN'S HEALTH SYSTEM OF TEXAS IS THE SOLE MEMBER FOR DALLAS PHYSICIAN MEDICAL SERVICES FOR CHILDREN (DPMSC). THEREFORE, DPMSC'S TOP MANAGEMENT OFFICIAL, OTHER OFFICERS, AND KEY EMPLOYEES ARE EMPLOYED AND COMPENSATED BY CHILDREN'S HEALTH SYSTEM OF TEXAS (CHST). The CHST process for determining executive compensation is as follows: The Human Resources Committee (Committee) of the CHST Board is responsible for setting the compensation for executives. The Committee is comprised of independent, non-employee directors. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness and defines the desired peer groups for compensation surveys. COMPENSATION PROGRAM COMPONENTS: The elements of total compensation provided to CHST executives include: - Cash compensation (i.e., base salary, short-term and long-term incentive compensation, and/or other cash compensation), determined in consideration of competitive market practices, organizational and individual performance, recruitment and retention considerations, and other relevant factors. - Standard benefits, assisting in each executive's medical, dental, disability, life insurance, time off, and retirement needs, reflective of the employment status (i.e., full or part time) of the executive. - Supplemental benefits, including supplemental insurance, retirement benefits, and/or other supplemental benefits determined by the Committee to be appropriate and reasonable in relation to marketplace practices. Compensation and benefits decisions are made in consideration of each executive's position, responsibilities, skills, effort, and performance, in relation to documented practices within the appropriate comparator group(s). PEER GROUP: The Committee has defined its primary peer group for executives as not-for-profit health care organizations similar in size, structure, and complexity. This group will include leading pediatric health systems as well as integrated health systems and academic medical centers. - Data will be compiled in a manner consistent with the IRS Intermediate Sanctions rules of federal tax law, to reflect what is "ordinarily paid to like executives by like enterprises under like circumstances." - In certain circumstances, market data from additional comparator groups (e.g., research institutions, insurance industry, and general industry companies) may also be referenced. - The specific nature of the role at CHST will be considered when adding comparator groups outside of the primary peer group, and the Committee will discuss and agree on the appropriateness of adding comparator groups whenever the specific nature of the CHST role requires additional comparator groups to be used. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Non-Qualified Retirement Plan: * Children's Health Savings Restoration Plan - There were no employees that received taxable income from the Savings Restoration Plan. Dr. William Morrow and Jerry Lee participated in the Savings Restoration Plan. Schedule J, Part I, Line 7 Non-fixed payments Non-Fixed Payments - The Human Resources Committee of the Board of Directors of Children's Health System of Texas retains the authority to adjust annual payout percentages solely at their discretion. There were no non-fixed payments in 2017. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL CHILDREN'S HEALTH SYSTEM OF TEXAS IS THE SOLE MEMBER FOR DALLAS PHYSICIAN MEDICAL SERVICES FOR CHILDREN (DPMSC). THEREFORE, DPMSC'S TOP MANAGEMENT OFFICIAL, OTHER OFFICERS, AND KEY EMPLOYEES ARE EMPLOYED AND COMPENSATED BY CHILDREN'S HEALTH SYSTEM OF TEXAS (CHST). The CHST process for determining executive compensation is as follows: The Human Resources Committee (Committee) of the CHST Board is responsible for setting the compensation for executives. The Committee is comprised of independent, non-employee directors. A written compensation philosophy has been developed by the Human Resources Committee for timeliness and appropriateness and defines the desired peer groups for compensation surveys. COMPENSATION PROGRAM COMPONENTS: The elements of total compensation provided to CHST executives include: - Cash compensation (i.e., base salary, short-term and long-term incentive compensation, and/or other cash compensation), determined in consideration of competitive market practices, organizational and individual performance, recruitment and retention considerations, and other relevant factors. - Standard benefits, assisting in each executive's medical, dental, disability, life insurance, time off, and retirement needs, reflective of the employment status (i.e., full or part time) of the executive. - Supplemental benefits, including supplemental insurance, retirement benefits, and/or other supplemental benefits determined by the Committee to be appropriate and reasonable in relation to marketplace practices. Compensation and benefits decisions are made in consideration of each executive's position, responsibilities, skills, effort, and performance, in relation to documented practices within the appropriate comparator group(s). PEER GROUP: The Committee has defined its primary peer group for executives as not-for-profit health care organizations similar in size, structure, and complexity. This group will include leading pediatric health systems as well as integrated health systems and academic medical centers. - Data will be compiled in a manner consistent with the IRS Intermediate Sanctions rules of federal tax law, to reflect what is "ordinarily paid to like executives by like enterprises under like circumstances." - In certain circumstances, market data from additional comparator groups (e.g., research institutions, insurance industry, and general industry companies) may also be referenced. - The specific nature of the role at CHST will be considered when adding comparator groups outside of the primary peer group, and the Committee will discuss and agree on the appropriateness of adding comparator groups whenever the specific nature of the CHST role requires additional comparator groups to be used. Form 990, Part VI, Line 6 Classes of members or stockholders Children's Health System of Texas (CHST) is the sole member. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Directors are appointed by the sole member and approved by the current DPMSC Board of Directors. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Member reserve powers are specified in the organization's bylaws and represent those actions by the organization which require member approval to be effective. These powers generally encompass changes in the mission of the organization, addition of new members, certain dispositions of assets, amendments to the organization's Certificate of Formation and Bylaws, and appointment of directors. Form 990, Part VI, Line 11b Review of form 990 by governing body Dallas Physician Medical Services for Children has delegated its oversight and review of the Form 990 to the Board of Directors of Children's Health System of Texas (CHST), its Sole Member. A draft of the Form 990 is presented to the CHST Audit Committee for review prior to filing. A copy of the Final Form 990 is made available to the CHST directors through our Board portal before it is filed. Form 990, Part VI, Line 12c Conflict of interest policy Officers, directors, and key employees received a copy of the Statement of Interest form to execute. Disclosures made are reviewed by the CHST Legal Department and the Chief Compliance Officer and discussed as necessary at the appropriate Committee and Board meetings to determine if further action is needed. Form 990, Part VI, Line 19 Required documents available to the public Certificate of Formation, Consolidated Financial Statements , and the conflict of interest policy is made available upon request. Form 990, Part IX, Line 11g Other Fees Consulting & Professional fees - Total Expense: 19167, Program Service Expense: 19167, Management and General Expenses: , Fundraising Expenses: ; Contract Medical - Total Expense: 2218285, Program Service Expense: 2218285, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Rounding - 1; Children's Medical Center of Dallas 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 750800628 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false Children's Medical Center Foundation 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752062015 Foundation TX 501(c)(3) 7 CHILDREN'S HEALTH SYSTEM OF TEXAS false Anesthesiologists for Children 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752917570 PHYSICIANS TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false Physicians for Children 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 810584868 PHYSICIANS TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false COMPLEX CARE MED SVC CORP 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461893597 MEDICAL SERVICES TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MEDICAL CENTER HEALTH PLAN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 462737696 HMO TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S MED CTR RESEARCH INST AT UTSWMC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 453462044 RESEARCH INSTITUTE TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false PEDIATRIC PARTNERS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 461917702 CLINICALLY INTEGRATED NETWORK TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S POPULATION HEALTH 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463104601 POPULATION HEALTH TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false CHILDREN'S HEALTH SYSTEM OF TEXAS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752062019 MANAGEMENT COMPANY TX 501(c)(3) Type II N/A false OCH Holdings 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 474837308 Hospital TX 501(c)(3) 3 CHILDREN'S HEALTH SYSTEM OF TEXAS false PHYSICIANS QUALITY ALLIANCE OF NORTH TEXAS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 464049491 PHYSICIANS TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false SOUTHWESTERN MEDICAL DISTRICT 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 204101612 MEDICAL DISTRICT TX 501(c)(3) Type I N/A false WOMEN'S AUXILIARY OF CMCD 12720 HILLCREST RD DALLAS TX 75230 752485538 WOMEN'S AUXILIARY TX 501(c)(3) 10 N/A false THE HEALTH AND WELLNESS ALLIANCE FOR CHILDREN 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 463080586 PHYSICIANS TX 501(c)(3) Type I CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 1 1935 Medical District Drive Dallas TX 75235 813582843 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 2 1935 Medical District Drive Dallas TX 75235 813679995 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 3 1935 Medical District Drive Dallas TX 75235 813691209 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 4 1935 Medical District Drive Dallas TX 75235 814577909 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 5 1935 Medical District Drive Dallas TX 75235 814848085 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false CHST Physician Group 6 1935 Medical District Drive Dallas TX 75235 814865847 Physician TX 501(c)(3) 10 CHILDREN'S HEALTH SYSTEM OF TEXAS false Wellness Innovations LLC 1935 Medical District Drive Dallas TX 75235 475246461 Physicians TX CHST Investment Holdings LLC Unrelated false false 0 ALTERNATIVE CARE SYSTEMS 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 752244475 OTHER MEDICAL SERVICES TX CHST C Corporation 0 false NTPSS INC 1935 MEDICAL DISTRICT DRIVE DALLAS TX 75235 471036641 PHYSICIAN SOLUTIONS TX Pediatric Partners C Corporation 0 false Texas Bluebonnet Insurance Company 1935 Medical District Drive Dallas TX 75235 475032893 Insurance Company TX CHST C Corporation 0 false TEXAS TRINITY RIVER ASSURANCE COMPANY LTD 878 West Bay Road PO Box 1159 Grand Cayman Grand Cayman CJ KY11202 981318151 Self-insurance CJ CHST C Corporation 0 false Wellness Innovations Physician Partners 1935 Medical District Drive Dallas TX 75235 811734937 Physicians TX CHST C Corporation 0 0 0 false Children's BMG 1935 Medical District Drive Dallas TX 75235 475057374 Physicians TX CHST C Corporation 0 0 0 false false false false false true false false false false false false true true true true true false false false